ESR elevated 90% of the time even in immunocompromised state with infection.

Xray: consider only lateral X-ray when looking for trauma or if you are going to just do xray. Full lumbar series has same gonadal radiation as PA/lateral CXR done daily for a year.

Disorders

Nonspecific back pain: Only 15% of back pain will have specific diagnosis. Tx: activity, no bedrest, analgesia. Medications: tylenol/NSAIDs.Lowest dose NSAID to avoid GI issues. Rosen doesn’t recommend muscle relaxants. Cochrane study showed only slight benefit over placebo with side effects likely worse than any effect. Chronic back pain: make sure you didn’t overlook any previous workup/process. Annulus fibrosis tear causes nerve irritation with pain radiating down legs, but only to knee.

Disc herniations: 95% of disc herniations with have sciatica symptoms. 95% of herniated discs occur at L4-L5, L5-S1 due to most flexion of back occurring at lumbosacral joint. NSAIDs less effective than compared to treatment for nonspecific back pain. Oral steroids have little benefit for sciatica (varied opinion. Another mentioned only slight benefit with 1x dose of IV 10mg decadron). MRI needed only for severe symptoms or progressive neurological deficits. Surgery only if still present after 4-6 weeks of failed improvement. 70% after surgery get some relief though at 4-10 year mark, same results as no surgery.